OLTL Update PANAC June 2012

1. OLTL UpdatePANAC June 2012 Ruth Anne Barnard, RN BSN OLTL Catharine B. Petko, RN BSN Myers and Stauffer LC

2. CMS Directives • Facilities must not inactivate a DRA (A0310F = 11) and resubmit the same data as a DRNA (A0310F = 10) • Facilities must not submit a second discharge with the same discharge date to identify a DRNA for that date • If the resident was expected to return when discharged, the DRA will be the final record

3. Discharge After Discharge Change Form • Available on PA Case-Mix web site and Bulletins section of CMS MDS Welcome Page • Applicable to residents who were DRA in the month before the picture date and will not be returning • Could be used with any ISC where A0310F = 11

4. Data • Picture Date • Facility ID • Requestor ID/contact information • HIPAA constraints • Do not submit resident’s name or SSN • Submit Resident ID • Submit Assessment ID • Submit Discharge Date (A2000)

5. S8010H1 • Check this item if the assessment is a Discharge Return Anticipated Assessment (DRA) AND is to be used as a Discharge Assessment Return Not Anticipated (DRNA) for Picture Date reporting requirements

6. Definitions • Residents who have been Discharged Return Anticipated (A0310F = 11) and have not exceeded 30 days absence after the discharge date by the picture date will appear on the non-MA list on the CMI Report. If the NF knows the resident will not be returning, e.g., has died, discharged to another facility or home, use this item to convey this information to remove the resident from the CMI Report.

7. Coding • Complete only if A0310F = 11 (Discharge return anticipated) • Vendors notified and will be upgrading software • If A0310F is not equal to 11, the item is skipped: software fills with caret (^)

8. Coding • Do not check this item (submit as 0) if: • this is an original assessment (A0050 = 1) or • this discharge assessment is being modified (A0050 = 2) for reasons other than using this DRA as a DRNA for Picture Date reporting requirements or • the Assessment Reference Date of the assessment is more than 30 days before the Picture Date or • you still expect the resident back

9. Coding • Designate A0050 = 2 Modification • Check this item (submit as 1) to use this DRA as a DRNA for Medical Assistance Picture Date reporting requirements • Qualifiers • Discharge date is within month before PD • A0310F = 11 DRA • NF knows resident will not be returning

10. Item Subset Codes • NC – Comprehensive • NQ – Quarterly • NP – PPS • ND – Discharge • NSD – SOT OMRA and Discharge • NOD – EOT, EOT-R or COT OMRA and Discharge

11. CMI Report Review • Help desk: contact NF if CMI Report contains duplicates, non-valids • NF must review; PD closes and no changes • Check file number carefully • Check batch number at bottom of first page; today’s data not received until tomorrow

12. Occupancy Calculations and Bed hold Billing • 7/1/10: To qualify for a hospital reserved bed day payment, a facility’s overall occupancy rate for the associated rate quarter has to equal or exceed 85% • Calculated by dividing the total number of assessments on the CMI Report by the number of certified beds

13. Occupancy Calculations and Bed hold Billing (2) • Data used from last three PDs • Only one of last three percentages must be 85% or higher • Affects “associated rate quarter” • Dates specified on CMI Report page • Begins 5 months after PD, e.g., calculations on the 5/1 CMI Report affect billing for quarter from 10/1 - 12/31

14. Occupancy Calculations and Bed hold Billing (3) • Field Operations • Technical assistance to NFs since February • Claim adjustments

15. FY 2012-13 NF Rates • FY 2012-13 … 3rd year of the 3-year phase-in to RUG v 5.12 and use of the latest classifiable assessments (25% v 5.01 / 75% v 5.12) • FY 12-13 BAF will no longer be adjusted each quarter; An annual BAF will be set with the July 1 rates and then reviewed in April 2013.

16. Weights • K0200B Weight: “Base weight on most recent measure in the last 30 days” • K0300 Weight Loss: Loss of 5% or more in the last month or loss of 10% or more in last 6 months • RAI Manual K-4 and K-5: “This item compares the resident’s weight in the current observation period with his or her weight at two snapshots in time: • At a point closes to 30-days preceding the current weight • At a point closest to 180-days preceding the current weight”

17. K0300 OLTL Review • K0300 Weight Loss is a RUG item potentially affecting classification • Most recent weight within last 30 days prior to ARD will be accepted as “current weight”

18. Comparison Weights 1. Go back 30 days from the date of the current weight. Identify a weight taken within a 14-day window (+ or – 7 days of the 30th day), i.e., between 23 days before the current weight to 37 days before the current weight 2. Go back 180 days from the date of the current weight. Identify a weight taken within a 14-day window (+ or – 7 days of the 180th day), i.e., between 173 days before the current weight to 187 days before the current weight.

19. NF Discharges & Field Operations • Question: Resident is in the NF. The individual goes to the hospital. The individual is in the hospital a long time; greater than 30 days. The individual plans to return to the NF after the hospital. What to do with the individuals chart in the NF. Do you take it apart or continue it or what?

20. NF Discharges & Field Operations • Two issues concern Field Operations • MDS Regulations • After 30 Days the individual is considered a New Admission • OBRA Regulations • Per OBRA Regulation: NF’s cannot d/c to a hospital, only to a home or community living setting • If NF decides to breakdown that chart, the NF must develop protocol so the information is available for an OBRA Review.

21. Final Participation Review Regs • Final form Participation Review regs to be published in the PA Bulletin by June 30, 2012

22. Nursing Facility PSAE Final Notice • The Final Notice/Bulletin regarding the Nursing Facility Preventable Serious Adverse Events program to be published in the PA Bulletin

23. Case Mix Information Website • http://www.portal.state.pa.us/portal/server.pt/community/long-term_care_case_mix_information/19342 • Resident Data Reporting Manual • Discharge after Discharge Change form

24. Questions? • Department of Health questions • QA-MDS@pa.gov • Medicaid/CMI/Field Operations questions • rbarnard@pa.gov • 717-214-3736 • Myers & Stauffer • Helpdesk 717-541-5809